Module 53, Pediatric Orthopaedic Level

1,2,3,4

This 9 year old girl was diagnosed as having sickle cell anemia during early childhood. She experienced two major crises each year, treated with hydration and pain medication. Her first bone symptoms occurred at age 9 following a crises with concomitant left hip pain (image1 & 2). Bone scan was also obtained which demonstrated a cold area. This girl was followed until age 14 when she presented with a 2 month history of left hip pain, aggravated with activity. Clinical findings were again not suggestive of infection (image 3). Two months later she under went a left hip core decompression and bone grafting without problem(image 4). Rehabilitation was steady maintaining a restriction on weight bearing and encouraging range of motion. She had a significant decrease in her pain.

Question 53A

This treatment is expected to prevent further collapse of the femoral head.

Question 53B

An important aspect during hip surgery on adolescents is to have blood available and plan a transfusion.

Question 53C

Four years later, she is able to ambulate without any aids but complains of a dull ache in her left hip and a limitation in rotation. Now at age eighteen, a total hip replacement is the best option and she should do as well as others with chronic joint degeneration should as rheumatoid arthritis.

Question 53D

Salmonella is the most common infectious organism in osteomyelitis in individuals with sickle cell disease.

Question 53E

Children in mid-childhood with sickle cell disease develop avascular necrosis of the femoral head which responds similar to Perthes disease of the hip.